PMID- 29150228
OWN - NLM
STAT- MEDLINE
DCOM- 20180613
LR  - 20220129
IS  - 1532-2165 (Electronic)
IS  - 1078-5884 (Linking)
VI  - 54
IP  - 6
DP  - 2017 Dec
TI  - Surgeons' Perceptions of the Causes of Preventable Harm in Arterial Surgery: A 
      Mixed-Methods Study.
PG  - 778-786
LID - S1078-5884(17)30638-X [pii]
LID - 10.1016/j.ejvs.2017.10.003 [doi]
AB  - BACKGROUND: System factors contributing to preventable harm in vascular patients 
      have not been previously reported in detail. The aim of this exploratory 
      mixed-methods study was to describe vascular surgeons' perceptions of factors 
      contributing to adverse events (AEs) in arterial surgery. A secondary aim was to 
      report recommendations to improve patient safety. METHODS: Vascular 
      consultants/registrars working in the British National Health Service were 
      questioned about the causes of preventable AEs through survey and semi-structured 
      interview (response rates 77% and 83%, respectively). Survey respondents 
      considered a recent AE, indicating on a 5 point Likert scale the extent to which 
      various factors from a validated framework contributed toward the incident. 
      Semi-structured interviews were conducted to obtain detailed accounts of 
      contributory factors, and to elicit recommendations to improve safety. RESULTS: 
      Seventy-seven surgeons completed the survey on 77 separate AEs occurring during 
      open surgery (n = 41) and in endovascular procedures (n = 36). Ten interviewees 
      described 15 AEs. The causes of AEs were multifactorial (median number of 
      factors/AE = 5, IQR 3-9, range 0-25). Factors frequently reported by survey 
      respondents were communication failures (36.4%; n = 28/77); inadequate staffing 
      levels/skill mix (32.5%; n = 25/77); lack of knowledge/skill (37.3%; n = 28/75). 
      Themes emerging from interviews were team factors (communication failure, lack of 
      team continuity, lack of clarity over roles/responsibilities); work environment 
      factors (poor staffing levels, equipment problems, distractions); inadequate 
      training/supervision. Knowledge/skill (p = .034) and competence (p = .018) 
      appeared to be more prominent in causing AEs in open procedures compared with 
      endovascular procedures; organisational structure was more frequently implicated 
      in AEs occurring in endovascular procedures (p = .017). To improve safety, 
      interviewees proposed team training programmes (5/10 interviewees); additional 
      protocols/checklists (4/10); improved escalation procedures (3/10). CONCLUSION: 
      Vascular surgeons believe that AEs in arterial operations are caused by multiple, 
      modifiable system factors. Larger studies are needed to establish the relative 
      importance of these factors and to determine strategies that can effectively 
      address system failures.
CI  - Copyright (c) 2017 European Society for Vascular Surgery. Published by Elsevier 
      Ltd. All rights reserved.
FAU - Lear, Rachael
AU  - Lear R
AD  - Department of Surgery & Cancer, Imperial College London, UK; Faculty of Health, 
      Social Care and Education, Kingston University and St George's University of 
      London, UK. Electronic address: r.lear12@imperial.ac.uk.
FAU - Godfrey, Anthony D
AU  - Godfrey AD
AD  - Department of Surgery & Cancer, Imperial College London, UK.
FAU - Riga, Celia
AU  - Riga C
AD  - Department of Surgery & Cancer, Imperial College London, UK; Imperial Vascular 
      Unit, Imperial College Healthcare National Health Service Trust, London, UK.
FAU - Norton, Christine
AU  - Norton C
AD  - Faculty of Nursing and Midwifery, King's College London, UK.
FAU - Vincent, Charles
AU  - Vincent C
AD  - Department of Experimental Psychology, Medical Sciences Division, Oxford 
      University, UK.
FAU - Bicknell, Colin D
AU  - Bicknell CD
AD  - Department of Surgery & Cancer, Imperial College London, UK; Imperial Vascular 
      Unit, Imperial College Healthcare National Health Service Trust, London, UK; 
      Centre for Health Policy, Imperial College London, UK.
LA  - eng
GR  - CDRF-2012-03-040/DH_/Department of Health/United Kingdom
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20171115
PL  - England
TA  - Eur J Vasc Endovasc Surg
JT  - European journal of vascular and endovascular surgery : the official journal of 
      the European Society for Vascular Surgery
JID - 9512728
SB  - IM
CIN - Eur J Vasc Endovasc Surg. 2017 Dec;54(6):787. PMID: 29129458
MH  - *Attitude of Health Personnel
MH  - Clinical Competence
MH  - Communication
MH  - Humans
MH  - Intraoperative Complications/diagnosis/*etiology/*prevention & control
MH  - Medical Errors/*prevention & control
MH  - Risk Factors
MH  - Surveys and Questionnaires
MH  - United Kingdom
MH  - Vascular Surgical Procedures/*adverse effects
MH  - Workload
OTO - NOTNLM
OT  - Communication
OT  - Endovascular procedures
OT  - Patient safety
EDAT- 2017/11/19 06:00
MHDA- 2018/06/14 06:00
CRDT- 2017/11/19 06:00
PHST- 2017/05/17 00:00 [received]
PHST- 2017/10/02 00:00 [accepted]
PHST- 2017/11/19 06:00 [pubmed]
PHST- 2018/06/14 06:00 [medline]
PHST- 2017/11/19 06:00 [entrez]
AID - S1078-5884(17)30638-X [pii]
AID - 10.1016/j.ejvs.2017.10.003 [doi]
PST - ppublish
SO  - Eur J Vasc Endovasc Surg. 2017 Dec;54(6):778-786. doi: 
      10.1016/j.ejvs.2017.10.003. Epub 2017 Nov 15.